Cyberknife Stereotactic Radiosurgery/Radiotherapy System DICOM 3.0 Conformance Statement

Cyberknife Stereotactic Radiosurgery/Radiotherapy System DICOM 3.0 Conformance Statement P/N 019055, Rev. N i

Cyberknife Robotic Radiosurgery System DICOM 3.0 Conformance Statement P/N 019055, Rev. N i

CyberKnife Robotic Radiosurgery System DICOM 3.0 Conformance Statement Copyright 2014 by Accuray Incorporated All Rights Reserved Part number: P/N 019055 Revision: N Telephone: 408-716-4600 Customer Service: 877-668-8667 Fax: 408-716-4601 This document, the software ( 2001-2014), and products to which this document refers, and any other related materials are the copyrighted and proprietary information of Accuray Incorporated and may not be used or distributed without written authorization of Accuray Incorporated. No part of this document may be photocopied, reproduced, or translated into another language without written permission from Accuray Incorporated. Accuray Incorporated reserves the right to revise this publication and to make changes in content from time to time without obligation on the part of Accuray Incorporated to provide notification of such revision or change. Accuray Incorporated provides this document without warranty of any kind, either implied or expressed, including, but not limited to, the implied warranties of merchantability and fitness for a particular purpose. Accuray Incorporated and its principals, officers, representatives, subsidiaries, employees, agents, heirs and assigns assume no responsibility or liability, either express or implied, for injury, death, or losses to consumers, users or service personnel resulting from improper handling of the Accuray products by unauthorized, untrained or otherwise unqualified personnel. Accuray Incorporated expressly denies any responsibility or liability for abuse, neglect, misuse or tampering with Accuray system components by persons not authorized, trained or otherwise associated with Accuray Incorporated. CyberKnife is a trademark of Accuray Incorporated All other products or services mentioned in this manual are identified by the trademark or service marks of their respective companies or organizations. Accuray Incorporated disclaims any responsibility for specifying which marks are owned by which companies or organizations. ii P/N 019055, Rev. N

REVISION HISTORY Rev. ECO # Description of Change Revised By Date A 1119 Initial Release. J. R. Dooley 7/12/02 B 1453 V3.2.2 Open Architecture Release. J. R. Dooley 6/25/03 C 1660 V3.3.3 Open Architecture Release J. R. Dooley 12/17/03 D 2010 CyRIS InView 1.1.0 Product Release J. R. Dooley 9/3/04 E 2259 CyRIS MultiPlan 1.3.0 Product Release J. R. Dooley 6/1/05 F 3536 CyberKnife MultiPlan 2.0 Product Release I-Ning Chang 12/1/06 G 4440 CyberKnife MultiPlan 2.1 Product Release I-Ning Chang 11/15/07 H 4766 CyberKnife 8.0 Product Release D. R. DeWitt 5/14/08 J 5099 CyberKnife 8.5 Product Release I-Ning Chang J. Cambra K 5709 CyberKnife 9.0 Product Release I-Ning Chang Annie Ju L 6066 CyberKnife 9.5 Product Release I-Ning Chang J. Cambra 3/16/09 6/25/10 04/14/2011 M 7897 Changes to RTSS export format David Scherch 3/10/2014 N ECO-02231 Removed CE Mark D. Peterson See Agile P/N 019055, Rev. N v

Cover Page Company Name: Accuray Incorporated. Product Name: CyberKnife Version: 3.0.x Release Internal document number: 019055 N vi P/N 019055, Rev. N

1 CONFORMANCE STATEMENT OVERVIEW The CyberKnife System currently supports CT, MR, PET, 3DRA image studies with up to 4 patient positions: HFS (head-first supine), FFS (feet-first supine), HFP (head-first prone), and FFP (feet-first prone). Contact Accuray for a list of supported patient positions for each modality. DICOM RT Structure Set is the RT object that can be imported from verified external nodes into the CyberKnife On-Target TM, MultiPlan and InView applications. Contact Accuray for a complete, current list of external nodes. DICOM RT Structure Set and RT Dose are currently the RT objects that can be exported from the CyberKnife System and MultiPlan System. In CyberKnife 9.0 and later systems, DICOM RT Plan and RT Beams Treatment Record can be exported from the CyberKnife System. Exportable DICOM RT Dose information includes a multi-frame volume dose grid, dose volume histograms (DVH), and isodose curves. This RT Dose could be imported into InView to review the DVH, isodose curves/clouds, and statistical information. Also the dose grid and DVH of RT Dose could be imported into ITC Remote Review Tool 34 after pushing to the ITC DICOMPiler software 5 for adding DICOM File Meta Information and Clinical Trial Subject C.7.1.3 module (0012 00xx), and the anonymization. The 16 February, 2001 are ATC Compliant 4 after the version 1.5.1 product release 6. Regarding Part 10 file format, our software, as of version CyberKnife 5.2.0, can export DICOM part 10 files. After pushing back to InView and CyberKnife databases via CTN_SEND/ CTN_STORAGE/ CTN_ARCHIVE applications, CTN s DICOM server will trim DICOM File Meta Information out because it only supports Implicit VR Little Endian Transfer Syntax prior to the CyberKnife 8.5. The 16 February, 2001 1.6, and the CyberKnife Data Management System (CDMS) 1.0/1.1 do not support those images that have two Image Header (0028,xxxx) for two Pixel Data(7FE0,0010), i.e. two instances of the Image Pixel Module, within one slice image file. The CyberKnife System and MultiPlan System support 3D X-Ray rotational angiography(3dra) in axial and coronal slices of XA modality, whose volumes are routinely generated from rotational angiography sequences - currently for Philips and Siemens machines which are capable of performing high speed rotational acquisition that enables 3D reconstruction. The CyberKnife System does not support 2D X-Ray angiographic projection image. Contact Accuray for the recommended scanning protocol. The DICOM application entity for the CyberKnife System evolved with different product releases in the below table. Table 1. The DICOM Application Entity for the CyberKnife System CyberKnife Version CKS 2.x/3.x/4.x CKS 5.x/6.x/7.x/8.0/8.1 CKS 8.5 and later Application Entity CTN_STORAGE/ CTN_SEND CTN_STORAGE/ CTN_ARCHIVE/ CTN_SEND CDMS_STORAGE/ CDMS_SEND/ CDMS_QR/ CDMS_UPS P/N 019055, Rev. N vii

Conformance Statement Overview 1.1 For CyberKnife 7.x and Earlier Systems Only Images received are sorted by Study Instance UID; all images received with the same Study UID will be grouped into the same case in the CyberKnife central database. Multiple modalities could be within the same case. Also, note that images received with the same Study Instance UID and modality over different associations will be imported to the CyberKnife central database just once. So, the user should ensure that a complete image study has been exported to the CyberKnife System before importing that study to the CyberKnife central database. Note that image series of the same modality are effectively concatenated into a single series. This allows the user to scan the patient anatomy for a single plan in two or more series. If, however, the user desires to divide the scans for separate treatment plans of different anatomical regions, the user should ensure that the scans have different Study Instance UIDs. Beginning with CyberKnife 4.3.0 patch (On-Target TM 3.6.0 patch) or CyberKnife Japanese Maintenance 3.4.0.4, the split series feature is provided for users needs. The DICOM server used is available at all times except during treatment delivery. 1.2 For CyberKnife 8.0 and Later Systems Only With the 8.0 release the split option has been removed. Series with the same modality will be treated as separate series. A merge option is available if two image series represent a single image series. The following are other changes that apply to CyberKnife release 8.0 and beyond. Series are imported using the Image Review and Import application located on the Administration Workstation. DICOM server has been relocated to a dedicated data storage system. DICOM server accepts storage associations independently of treatment delivery 1 1.3 For CyberKnife 8.5 and Later Systems Only Beginning with the 8.5 release the CyberKnife System employs a new DICOM infrastructure based on the MergeCOM-3 TM Advanced Integrator's Toolkit 7 by Merge Healthcare TM. This DICOM interface is continuously implementing support for most recent updates to DICOM standards, which in turn enables the CyberKnife System to offer extensive DICOM capability including The newly added DICOM transfer syntaxes referenced below with their UIDs: Implicit VR Little Endian 2 (1.2.840.10008.1.2) Explicit VR Little Endian (1.2.840.10008.1.2.1) Explicit VR Big Endian (1.2.840.10008.1.2.2) JPEG Lossless coding Process 14 (1.2.840.10008.1.2.4.70) 1 The DICOM server is available 24/7 beginning with the 8.0 release. 2 The Implicit VR Little Endian is the only DICOM transfer syntax prior the CyberKnife 8.0 release. viii P/N 019055, Rev. N

Conformance Statement Overview The DICOM Files are stored in Part 10 format 3 Multi-threaded DICOM Server DICOM Interface utilizing RT Plan, RT Beams Treatment Record, RT Beams Delivery Instruction8, and Unified Procedure Step 9 objects. The Standardized Uptake Value (SUV) of PET imaging for [F-18] fluorodexyglucose (FDG) studies that is commonly used to differentiate malignant from benign tumors and to assess the efficacy of therapy. Beginning with the 9.0 release the CyberKnife System supports PET SUV calculation based on the standard DICOM attributes, such as SIEMENS Biograph or CPS/ECAT systems, and the private DICOM attributes, such as GE Advance and Discovery family systems and PHILIPS AllegroTM and GeminiTM systems. An Oncology Information System (OIS) provides workflow solutions for radiation therapy and radiosurgery treatment delivery. Beginning with the 9.0 release the CyberKnife System utilizes the industry-standard DICOM protocol to (1) export patient treatment plan to an OIS for charting and scheduling, (2) query the OIS for scheduled treatment sessions and (3) export treatment results following delivery. The Dynamic Contrast Enhanced MR imaging (DCE MRI) is a well-established method for detecting and quantifying tumor angiogenesis. Beginning with the 9.5 release the CyberKnife System supports DCE MR images and the Pharmacokinetics data created by the icad MR Analysis System (SpectraLook, VividLook and OmniLook ) based on the standard and private DICOM attributes from icad system. There are well-known Quality Assurance(QA) tools offered to compare a scanned film with a 2D planar dose created from the treatment plan. Beginning with the 9.5 release the CyberKnife System supports 2D planar dose export in the DICOM RT Dose for axial, coronal and sagittal planes, but the 2D planar dose is not intended to use in any InView system. 3 The DICOM file is stored in DICOM stream format prior the CyberKnife 8.0 release. P/N 019055, Rev. N ix

TABLE OF CONTENTS 1 Conformance Statement Overview... vii 1.1 For CyberKnife 7.x and Earlier Systems Only... viii 1.2 For CyberKnife 8.0 and Later Systems Only... viii 1.3 For CyberKnife 8.5 and Later Systems Only... viii 2 Introduction... 1 2.1 Applicability... 1 2.2 Acronyms/Terminology... 1 2.3 References... 3 3 Implementation Model... 4 3.1 Application Data Flow Diagram... 4 3.1.1 For CyberKnife 7.x and Earlier Systems Only... 4 3.1.2 For CyberKnife 8.0/8.1 Systems Only... 4 3.1.3 For CyberKnife 8.5 and Later Systems Only... 5 3.2 Functional Definitions of Application Entity... 8 3.2.1 For CyberKnife 8.1/8.0/7.x and Earlier Systems Only... 8 3.2.2 For CyberKnife 8.5 and Later Systems Only... 8 3.3 Sequencing of Real-World Activities... 8 3.3.1 For CyberKnife 9.0 and Later Systems Only... 9 4 AE Specifications... 11 4.1 Supported Storage Service Object Pair (SOP) Classes by CyberKnife System as an SCP... 11 4.1.1 Association Establishment Policies... 11 4.1.2 Association Initiation Policy... 12 4.1.3 Association Acceptance Policy... 12 4.2 Supported Storage, Unified Procedure Step, Query/Retrieve Service Object Pair (SOP) Classes by CyberKnife System as an SCU... 30 4.2.1 Association Establishment Policies... 31 4.2.2 Association Initiation Policy... 32 4.2.3 Association Acceptance Policy... 47 5 RT Structure Set Information Object Implementation (RT Structure Set Storage SCP)48 5.1 RT Structure Set IOD Implementation... 48 5.1.1 Entity Relationship Model... 48 5.1.2 CyberKnife Mapping of DICOM Entities... 48 5.2 RT Structure Set IOD Module Table... 48 5.3 Information Module Definitions RT Structure Set... 49 5.3.1 Structure Set Module... 49 5.3.2 ROI Contour Module... 50 5.3.3 RT ROI Observations Module... 52 P/N 019055, Rev. N i

Table of Contents 6 RT Structure Set Information Object Implementation (RT Structure Set Storage SCU)54 6.1 RT Stucture Set IOD Implementation... 54 6.1.1 Entity Relationship Model... 54 6.1.2 CyberKnife Mapping of DICOM Entities... 54 6.2 RT Structure Set IOD Module Table... 55 6.3 Information Module Definitions RT Structure Set... 55 6.3.1 Structure Set Module... 55 6.3.2 ROI Contour Module... 57 6.3.3 RT ROI Observations Module... 58 7 RT Dose Information Object Implementation (RT Dose Storage SCP)... 60 7.1 RT Dose IOD Implementation... 60 7.1.1 Entity Relationship Model... 60 7.1.2 CyberKnife Mapping of DICOM Entities... 60 7.2 RT Dose IOD Module Table... 61 7.3 Information Module Definitions RT Dose... 61 7.3.1 RT Dose Module... 61 7.3.2 RT DVH Module... 62 7.3.3 Structure Set Module... 63 8 RT Dose Information Object Implementation (RT Dose Storage SCU)... 64 8.1 RT Dose IOD Implementation... 64 8.1.1 Entity Relationship Model... 64 8.1.2 CyberKnife Mapping of DICOM Entities... 64 8.2 RT Dose IOD Module Table... 65 8.3 Information Module Definitions RT Dose... 65 8.3.1 RT Dose Module... 65 8.3.2 RT DVH Module... 66 8.3.3 Structure Set Module... 68 8.3.4 ROI Contour Module... 69 8.3.5 RT Dose ROI Module... 70 9 RT Plan IOD (RT Plan Storage SCU)... 71 9.1 RT Plan IOD Implementation... 71 9.1.1 Entity Relationship Model... 71 9.2 RT Plan IOD Module Table... 71 9.3 Information Module Definitions RT Plan... 72 10 RT Plan IOD (RT Plan Storage SCP)... 82 10.1 RT Plan IOD Implementation... 82 10.1.1 Entity Relationship Model... 82 10.2 RT Plan IOD Module Table... 82 11 RT Beams Treatment Record IOD (RT Beam Treatment Record Storage SCU)... 83 ii P/N 019055, Rev. N

Table of Contents 11.1 RT Beams Treatment Record IOD Implementation... 83 11.1.1 Entity Relationship Model... 83 11.2 RT Beams Treatment Record IOD Module Table... 83 11.3 Information Model Definitions RT Beams Treatment Record... 84 12 RT Beams Delivery Instruction IOD (RT Beams Delivery Instruction Storage SCP)... 90 12.1 RT Beams Delivery Instruction IOD Implementation... 90 12.1.1 Entity Relationship Model... 90 12.2 RT Beams Delivery Instruction IOD Module Table... 90 12.3 Information Module Definitions RT Beams Delivery Instruction... 91 13 Unified Procedure Step IOD (Unified Procedure Step PULL SCU)... 92 13.1 Unified Procedure Step_IOD Implementation... 92 13.1.1 Entity Relationship Model... 92 13.2 Unified Procedure Step IOD Module Table... 92 13.3 Information Module Definitions Unified Procedure Step... 93 14 Study Root Query/Retrieve Information Model SCU... 95 14.1 Query/Retrieve (SCU) Implementation... 95 15 RT Treatment Summary Record IOD (RT Treatment Summary Record Storage SCP). 96 15.1 RT Treatment Summary Record IOD Implementation... 96 15.1.1 Entity Relationship Model... 96 15.2 RT Treatment Summary Record IOD Module Table... 96 15.3 Information Module Definitions RT Treatment Summary... 97 16 Communication Profiles... 99 16.1 Supported Communication Stacks... 99 16.2 Network Media Support... 99 17 Extensions, Specializations, Privatizations... 100 18 Configuration... 101 19 Support for Extended Character Sets... 102 20 Annexes... 103 20.1 Miscellaneous Macros... 103 20.2 Data Dictionary of Private Attributes... 103 20.2.1 GE Private Attributes for PET Images... 103 20.2.2 PHILIPS Private Attributes for PET Images... 104 20.2.3 VARIAN Private Attributes for OIS Interface... 104 20.2.4 icad Private Attributes for MR DCE Images... 105 P/N 019055, Rev. N iii

2 INTRODUCTION This document is a DICOM v3.0 1 Conformance Statement for the CyberKnife Robotic Radiosurgery System. It details the DICOM Service Classes and roles supported by this product. The CyberKnife System represents an entirely new approach to radiosurgery. Incorporating a compact, lightweight linear accelerator mounted on a robotic arm, the CyberKnife System provides the surgeon unparalleled flexibility in targeting. Advanced image guidance technology tracks patient and target position during treatment, ensuring accuracy without the use of an invasive head frame. The CyberKnife System is intended to provide radiosurgery for lesions anywhere in the body when radiation treatment is indicated. The CyberKnife System has often been used to radiosurgically treat otherwise untreatable tumors and malformations. The CyberKnife System prior to the 8.5 release was developed using MIR DICOM Software CTN v3.0.6 Tool Kit 2 for DICOM v3.0 Services supplied by Electronic Radiology Laboratory, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri USA. 2.1 Applicability This document is intended to facilitate DICOM data exchange between the CyberKnife System and other DICOM compliant systems. 2.2 Acronyms/Terminology 3DRA AE ATC CKS CDMS CT CTN DCE MRI DICOM DIMSE DVH EVF FSN IOD 3 Dimensional X-Ray Rotational Angiography Application Entity Advanced Technology Consortium CyberKnife System CyberKnife Data Management System Computerized Tomography Central Test Node Dynamic Contrast Enhanced Magnetic Resonance Imaging Digital Imaging and Communications in Medicine DICOM Message Dose-Volume Histogram Extra-cellular Volume Fraction based on Pharmacokinetics analysis of DCE MRI AccuFusion Image Registration Program Information Object Definition P/N 019055, Rev. N 1

Introduction IRI Ktrans NEMA MIR MIRIT MRI OIS PET PDU PERM ROI RTOG RSNA SCP SCU SOP SQL SUV TCP/IP TMS TPS UID UPS Ve VOI XA Image Review and ImportITC Image-Guided Therapy Center Same as PERM: permeability surface area product per unit volume of tissue National Electrical Manufacturers Association Mallinckrodt Institute of Radiology Medical Image Review and Import Tool Magnetic Resonance Imaging Oncology Information System Positron Emission Tomography Protocol Data Unit Vascular Permeability based on Pharmacokinetics analysis of DCE MRIQR Query and Retrieve Region of Interest Radiation Therapy Oncology Group Radiological Society of North America Service Class Provider (receiver) Service Class User (sender) Service Object Pair Structured Query Language Standardized Uptake Values Transmission Control Protocol/Internet Protocol Treatment Management System Treatment Planning System Unique Identification Unified Procedure Step Same as EVF: volume of extravascular extracellular space per unit volume of tissue Volume of Interest X-ray Angiography 2 P/N 019055, Rev. N

Introduction 2.3 References 1. Digital Imaging and Communications in Medicine Standard v3.0, National Electrical Manufacturers Association, 2008. 2. Stephen M. Moore, Conformance Statements for MIR CTN Applications, v2.11.0, Electronic Radiology Laboratory, Mallinckrodt Institute of Radiology, January 7, 2000. (http://wuerlim.wustl.edu/dicom/ctn-docs/doc_index.html) 3. ATC File Set Reader DICOM Conformance Statement v. 2.3. (http://itc.wustl.edu/dicom/conf_stmts.htm) 4. ATC Digital Data Submission Procedure (http://atc.wustl.edu/credentialing/data_submit/digital_submit_040818.htm) 5. ITC DICOMpiler Software (http://itc.wustl.edu/dicompiler/index.htm) 6. ATC Compliant Treatment Planning Systems Per Modality (http://atc.wustl.edu/credentialing/atc_compliant_tps.html) 7. MergeCOM-3 DICOM toolkit (http://www.mergecom3.com/index.htm) 8. Digital Imaging and Communications in Medicine, Supplement 74:Utilization of Worklist in Radiotherapy Treatment Delivery, Frozen Draft for Trial Implementation, 2007/10/08. (ftp://medical.nema.org/medical/dicom/supps/sup74_fz2.pdf) 9. Digital Imaging and Communications in Medicine, Supplement 96:Unified Worklist and Procedure Step, Frozen Draft for Trial Use, 2007/10/08. (ftp://medical.nema.org/medical/dicom/supps/sup96_fz2.pdf P/N 019055, Rev. N 3

3 IMPLEMENTATION MODEL The CyberKnife Systems prior to the 8.5 release uses the CTN application for creation of DICOM Storage Service Class server. The storage service classes, CTN_STORAGE/CTN_ARCHIVE Application Entity and CTN_SEND Application Entity, will act respectively in the role of an SCP and an SCU, and facilitates the transfer of a DICOM file between a location and a CKS workstation via a network. The CyberKnife 8.5 and later systems use the MergeCOM-3 TM Advanced Integrator's Toolkit for creation of DICOM Storage Service Class server. The storage service classes, CDMS_STORAGE Application Entity and CDMS_SEND Application Entity, will act respectively in the role of an SCP and an SCU, and facilitates the transfer of a DICOM file between a remote workstation and a CKS workstation via a network. 3.1 Application Data Flow Diagram 3.1.1 For CyberKnife 7.x and Earlier Systems Only The CTN_STORAGE server application stores received DICOM files within a standard UNIX directory 2. The DICOM files may then be imported into the CyberKnife central database via the MIRIT application. MIRIT is a CyberKnife application which provides the capability to review and import DICOM images to the CKS central database. When MIRIT is invoked, it will scan the directory of files, written by CTN_STORAGE, to determine if individual files may be associated. The association criterion is matching Study UID. If files belong to the same study they will be imported to CKS as a single dataset. The CTN_ARCHIVE server application imports the received DICOM files into an SQL database and a DICOM hierarchical directory 2 used by the InView and the MultiPlan Systems. The CTN_SEND application pushes the DICOM files to the remote AEs, supporting DICOM Storage as SCP. The DICOM files are exported from the CyberKnife On-Target or MultiPlan and InView applications, or are imported into the CyberKnife central database or InView local database. CTN_SEND is initiated by the user of the CyberKnife On-Target, MultiPlan or InView applications. 3.1.2 For CyberKnife 8.0/8.1 Systems Only The CTN_STORAGE server application stores received DICOM files onto the CDMS Data Server file system. These files are moved into the CDMS database following arrival. The DICOM files may then be reviewed and imported into a patient record using the CDMS IRI application located on the CDMS Administration Workstation. CTN_ARCHIVE server application imports the received DICOM files into the SQL database and a DICOM hierarchical directory 2 used by the InView and the MultiPlan Systems. 4 P/N 019055, Rev. N

Implementation Model The CTN_SEND application pushes the DICOM files to the remote AEs, acting as a DICOM Storage as SCP. The DICOM files can be exported from the CDMS Data Server, MultiPlan and InView applications. DICOM series are stored in the CDMS database or InView local database. CTN_SEND is initiated by the user of the MultiPlan and InView applications. CTN_SEND from CDMS Data Server can be initiated by the user of Plan Administration or DICOM Administration, located on the CDMS Administration Workstation, for both DICOM image and RT series. 3.1.3 For CyberKnife 8.5 and Later Systems Only The CDMS_STORAGE server application stores received DICOM files onto the CDMS Data Server file system. These files are moved into the CDMS database following arrival. The DICOM files may then be reviewed and imported into a patient record using the CDMS IRI application. The CDMS_SEND application pushes the DICOM files to the remote AEs, acting as a DICOM Storage as SCP. The DICOM files can be exported from the CDMS Data Server. The CDMS_SEND is initiated by the user of the MultiPlan System after exporting DICOM image and RT files. The user can initiate CDMS_SEND for both DICOM image and RT series on a CDMS Data Server from IRI, Plan Administration or DICOM Administration. The CDMS_QR is used to query a remote DICOM SCP for plans available for delivery and is initiated following launch of the CyberKnife System Treatment option. The CDMS_UPS is used to communicate the delivery intent to a remote Treatment Management System, and is initiated at the start of a treatment session. P/N 019055, Rev. N 5

Implementation Model DICOM Interface Import to CKS central database database Store to File CTN_STORAGE AE AE Remote Storage SCU SCU Verification Response Remote Verification SCU SCU Import to InView local database and MultiPlan cache database CTN_ARCHIVE AE Remote Storage SCU Verification Response Remote Verification SCU Export DICOM File CTN_SEND AE Remote Storage SCP Verification SCU Remote Verification Response Figure 1: Application Data Flow Diagram for the CyberKnife Systems prior to 8.5 release. 6 P/N 019055, Rev. N

Implementation Model DICOM Interface Import to CDMS database Store to File CDMS_STORAGE AE Remote Storage SCU Verification Response Remote Verification SCU Export DICOM File CDMS_SEND AE Remote Storage SCP Verification SCU Record Treatment Delivery Results Remote Verification Response Request to be Retrieved DICOM CDMS_QR AE Remote Retrieve SCP Query Patient/Plan List CDMS_UPS AE Remote UPS SCP Figure 2: Application Data Flow Diagram for the CyberKnife 8.5 and later systems. P/N 019055, Rev. N 7

Implementation Model 3.2 Functional Definitions of Application Entity 3.2.1 For CyberKnife 8.1/8.0/7.x and Earlier Systems Only The CTN_STORAGE server application waits until it receives a C-STORE request from a remote SCU. Upon receipt, it saves the received data to a directory with a unique file name. The server handles one association at a time. The CTN_ARCHIVE server application waits until it receives a C-STORE request from a remote SCU. Upon receipt, it saves the received data to a DICOM hierarchical directory with a unique file name and inserts the header information into the SQL database. The server handles multiple associations simultaneously. CTN_ARCHIVE is a service that runs continuously after boot of the 16 February, 2001 workstations. The CTN_SEND application invokes a C-STORE DIMSE service with a SOP instance and then an association will be established with the AE identified by the user. Information objects will be transferred one at a time until there are no more to transfer. CTN_SEND and CTN_STORAGE/CTN_ARCHIVE act as SCUs role and SCPs respectively for the SOP classes of the Storage Service Class. 3.2.2 For CyberKnife 8.5 and Later Systems Only The CDMS_STORAGE server application waits until it receives a C-STORE request from a remote SCU. Upon receipt, it saves the received data to a DICOM hierarchical directory with a unique file name and then inserts the header information into the CKS database. The server handles multiple associations simultaneously. CDMS_STORAGE is a service, started right after booting the CDMS Data Server workstation, which run continuously. The CDMS_SEND application invokes a C-STORE DIMSE service with a SOP instance. After this occurs, an association will be established with the AE identified by the user. Information objects will be transferred one at a time until have been transferred. CDMS_SEND and CDMS_STORAGE serve in the SCU role and the SCP role respectively for SOP classes of the Storage Service Class. CDMS_QR serves in the SCU role for the SOP class of the Query and Retrieve Service Class. CDMS_UPS serves in the SCU role for the SOP class of the Unified Procedure Step Service Class. 3.3 Sequencing of Real-World Activities The CyberKnife System has no way of knowing when it has a complete study or what constitutes a complete study. Users should be aware of how many DICOM image files constitute a complete image study before importing into the CyberKnife database. 8 P/N 019055, Rev. N

Implementation Model 3.3.1 For CyberKnife 9.0 and Later Systems Only The CDMS_UPS/CDMS_SEND perform a sequence of the treatment delivery normal activities as follows when communicating with the Aria Oncology Information System: CDMS UPS CDMS SEND Treatment Management System (TMS) Query UPS (C-FIND) Receive 0-n UPS Set UPS IN PROGRESS (N-ACTION) N-ACTION Response Set UPS 0% complete, Beam 1 (N-SET) N-SET Response... Set UPS 100% complete, Beam 1 (N-SET) N-SET Response Store RT Beams Treatment Record (C-STORE) C-STORE Response Set UPS COMPLETED (N-ACTION) N-ACTION Response Figure 3: Sequence Diagram CDMS_UPS/CDMS_SEND for CyberKnife 9.0 and later systems and ARIA Oncology Information System. The CDMS_UPS/CDMS_QR/CDMS_STORAGE/CDMS_SEND perform a sequence of the treatment delivery normal activities as follows when communicating with the MOSAIQ Oncology Information System: P/N 019055, Rev. N 9

Implementation Model CDMS UPS CDMS QR CDMS STORAGE CDMS SEND Treatment Management System (TMS) Query UPS (C-FIND) Receive 0-n UPS Retrieve TMS objects (C-MOVE) C-MOVE Response Store RT Plan, RT Beams Delivery Instruction, RT Treatment Summary (C-STORE) C-STORE Response Set UPS IN PROGRESS (N-ACTION) N-ACTION Response Set UPS 0% complete, Beam 1 (N-SET) N-SET Response Set UPS 100% complete, Beam 1 (N-SET) N-SET Response Store RT Beams Treatment Record (C-STORE) C-STORE Response Set UPS COMPLETED (N-ACTION) N-ACTION Response Figure 4: Sequence Diagram CDMS_UPS/CDMS_QR/CDMS_STORAGE/CDMS_SEND for CyberKnife 9.5 and later systems and MOSAIQ Oncology Information System. 10 P/N 019055, Rev. N

4 AE SPECIFICATIONS 4.1 Supported Storage Service Object Pair (SOP) Classes by CyberKnife System as an SCP Table 2. Storage SOP Classes Supported by CyberKnife as an SCP. SOP Class Name SOP Class UID Verification SOP Class 1.2.840.10008.1.1 CT Image Storage 1.2.840.10008.5.1.4.1.1.2 MR Image Storage 1.2.840.10008.5.1.4.1.1.4 Positron Emission Tomography Image Storage 1.2.840.10008.5.1.4.1.1.128 RT Dose Storage 1.2.840.10008.5.1.4.1.1.481.2 RT Structure Set Storage 1.2.840.10008.5.1.4.1.1.481.3 Philips Private CX Image Storage 1.3.46.670589.2.4.1.1 X-Ray Angiographic Image Storage 1.2.840.10008.5.1.4.1.1.12.1 RT Plan Storage 1.2.840.10008.5.1.4.1.1.481.5 RT Beams Delivery Instruction Storage 1.2.840.10008.5.1.4.34.1 RT Treatment Summary Record Storage 1.2.840.10008.5.1.4.1.1.481.7 4.1.1 Association Establishment Policies 4.1.1.1 General The default maximum PDU size which can be received by the CTN_STORAGE/CTN_ARCHIVE server is configurable with a default value of 16KB and a maximum value of 32KB. The default maximum PDU size which can be received by the CDMS_STORAGE server is configurable with a default value of 64KB and a minimum value of 4KB. The CTN_STORAGE server needs at least 150MB free disk space to run. For configuration information, see the Configuration section, page 101. 4.1.1.2 Number of Associations The number of simultaneous associations which will be accepted by the CTN_STORAGE/CTN_ARCHIVE/CDMS_STORAGE server are limited only by the kernel parameters of the underlying TCP/IP implementation. The CTN_STORAGE/CTN_ARCHIVE/CDMS_STORAGE server will spawn a new process/thread for each association request that it receives. Therefore, the P/N 019055, Rev. N 11

AE Specifications CTN_ARCHIVE/CDMS_STORAGE server can have multiple simultaneous connections, and there is no inherent limitation on the total number of simultaneous associations which the CTN_ARCHIVE/CDMS_STORAGE server can maintain. 4.1.1.3 Asynchronous Nature Not supported. 4.1.1.4 Implementation Identifying Information Not applicable. 4.1.2 Association Initiation Policy The CTN_STORAGE/CTN_ARCHIVE/CDMS_STORAGE AE does not initiate associations. 4.1.3 Association Acceptance Policy When CTN_STORAGE/CDMS_STORAGE accepts an association, it will receive supported image SOP Instances and store them on disk. CTN_STORAGE/CDMS_STORAGE does not limit who may connect to it. When the CTN_ ARCHIVE/CDMS_STORAGE accepts an association, it will receive supported image SOP Instances and store them in its database that needs to be configured in CTNControl database. The CTN_ ARCHIVE does not limit who may connect to it. When Verification SCP accepts an association it responds with a success status. 4.1.3.1 Associated Real-World Activity Store Request from an External Node The associated Real-World activity associated with the C-STORE operation is the storage of the image on the disk of the system upon which the CTN_STORAGE/CTN_ARCHIVE/CDMS_STORAGE server is running. Images are stored by writing the data set of the C-STORE command directory to disk with no further header or interpretation. The CTN_STORAGE/CTN_ARCHIVE/CDMS_STORAGE server application responds to remote C-ECHO requests. The CTN_STORAGE/CDMS_STORAGE server application will automatically handle request for image storage and store them on receipt of C-STORE requests. The file will be stored in the directory specified at startup of the daemon. The CTN_ARCHIVE server application updates an image database with patient, study, series and image information after the image is stored to disk. 4.1.3.2 Presentation Context Table Any of the Presentation Contexts shown in Table 3 is acceptable to the CyberKnife System for receiving and importing information objects. 12 P/N 019055, Rev. N

AE Specifications Table 3. Presentation Contexts for the CyberKnife System Presentation Contexts Table Abstract Syntax Transfer Syntax Role Extended Negotiation SOP Name UID Name UID Verification 1.2.840.10008.1.1 Implicit VR Little Endian Explicit VR Little Endian Explicit VR Big Endian 1.2.840.10008.1.2 SCP None 1.2.840.10008.1.2.1 1.2.840.10008.1.2.2 CT Image Storage MR Image Storage Positron Emission Tomography Image Storage 1.2.840.10008.5.1.4.1.1.2 Implicit VR Little Endian Explicit VR Little Endian Explicit VR Big Endian JPEG Lossless coding Process 14 1.2.840.10008.5.1.4.1.1.4 Implicit VR Little Endian Explicit VR Little Endian Explicit VR Big Endian JPEG Lossless coding Process 14 1.2.840.10008.5.1.4.1.1.128 Implicit VR Little Endian Explicit VR Little Endian Explicit VR Big Endian 1.2.840.10008.1.2 SCP None 1.2.840.10008.1.2.1 1.2.840.10008.1.2.2 1.2.840.10008.1.2.4.70 1.2.840.10008.1.2 SCP None 1.2.840.10008.1.2.1 1.2.840.10008.1.2.2 1.2.840.10008.1.2.4.70 1.2.840.10008.1.2 SCP None 1.2.840.10008.1.2.1 1.2.840.10008.1.2.2 P/N 019055, Rev. N 13

AE Specifications Presentation Contexts Table Abstract Syntax Transfer Syntax Role Extended SOP Name UID Name UID Negotiation RT Dose Storage RT Structure Set Storage Philips Private CX Image Storage X-Ray Angiographic Image Storage JPEG Lossless coding Process 14 1.2.840.10008.5.1.4.1.1.481.2 Implicit VR Little Endian Explicit VR Little Endian Explicit VR Big Endian 1.2.840.10008.5.1.4.1.1.481.3 Implicit VR Little Endian Explicit VR Little Endian Explicit VR Big Endian 1.3.46.670589.2.4.1.1 Implicit VR Little Endian Explicit VR Little Endian Explicit VR Big Endian JPEG Lossless coding Process 14 1.2.840.10008.5.1.4.1.1.12.1 Implicit VR Little Endian Explicit VR Little Endian Explicit VR Big Endian 1.2.840.10008.1.2.4.70 1.2.840.10008.1.2 SCP None 1.2.840.10008.1.2.1 1.2.840.10008.1.2.2 1.2.840.10008.1.2 SCP None 1.2.840.10008.1.2.1 1.2.840.10008.1.2.2 1.2.840.10008.1.2 SCP None 1.2.840.10008.1.2.1 1.2.840.10008.1.2.2 1.2.840.10008.1.2.4.70 1.2.840.10008.1.2 SCP None 1.2.840.10008.1.2.1 1.2.840.10008.1.2.2 JPEG 1.2.840.10008.1.2.4.70 14 P/N 019055, Rev. N

AE Specifications Presentation Contexts Table Abstract Syntax Transfer Syntax Role Extended SOP Name UID Name UID Negotiation Lossless coding Process 14 RT Plan Storage 1.2.840.10008.5.1.4.1.1.481.5 Implicit VR Little Endian Explicit VR Little Endian Explicit VR Big Endian 1.2.840.10008.1.2 SCP None 1.2.840.10008.1.2.1 1.2.840.10008.1.2.2 RT Beams Delivery Instruction Storage RT Treatment Summary Record Stroage 1.2.840.10008.5.1.4.34.1 Implicit VR Little Endian Explicit VR Little Endian Explicit VR Big Endian 1.2.840.10008.5.1.4.1.1.481.7 Implicit VR Little Endian Explicit VR Little Endian Explicit VR Little Endian 1.2.840.10008.1.2 SCP None 1.2.840.10008.1.2.1 1.2.840.10008.1.2.2 1.2.840.10008.1.2 SCP None 1.2.840.10008.1.2.1 1.2.840.10008.1.2.2 4.1.3.2.1 Presentation Context Acceptance Criterion The CTN_STORAGE/CTN_ARCHIVE server will accept any number of storage SOP classes that are listed in Table 3 above, provided that the requesting application is known to the CTN_ARCHIVE server and has been enabled to store images on the 16 February, 2001 (via a configuration step). The CTN_STORAGE/CTN_ARCHIVE/CDMS_STORAGE server doesn't define a limit on the number of presentation contexts accepted. In the event that the CTN_STORAGE/CTN_ARCHIVE/CDMS_STORAGE server runs out of resources when trying to accept multiple presentation contexts, it will reject the association request. The CTN_STORAGE/CTN_ARCHIVE server does not check for duplicate presentation contexts and will accept duplicate presentation contexts. P/N 019055, Rev. N 15

AE Specifications 4.1.3.2.2 Transfer Syntax Selection Policies The CTN_STORAGE/CTN_ARCHIVE server only supports the Implicit VR Little Endian transfer syntax. Any proposed presentation context which includes the Implicit VR Little Endian transfer syntax will be accepted with the Implicit VR Little Endian transfer syntax. Any proposed presentation context that does not include the Implicit VR Little Endian transfer syntax will be rejected. Note: DICOM Part 10 format is recommended to use one of the DICOM Transfer Syntaxes support explicit Value Representation encoding to facilitate interpretation of File Meta Element Values (See PS 3.5 of the DICOM Standard), such as Explicit VR Little Endian Transfer Syntax(UID=1.2.840.10008.1.2.1). The CDMS_STORAGE server supports the following transfer syntaxes. Implicit VR Little Endian, Explicit VR Little Endian, Explicit VR Big Endian, and JPEG Lossless coding Process 14. Any proposed presentation context are listed in above will be accepted with the listed transfer syntax sequence in order. Any proposed presentation context that is not listed in Table 3 above will be rejected. 4.1.3.3 SOP Specific Conformance to Verification SOP Class The CTN_STORAGE/CTN_ARCHIVE/CDMS_STORAGE provides standard conformance to the DICOM Verification Service Class. 4.1.3.4 SOP Specific Conformance to Storage SOP Class The table shown below lists the Modules that are received and imported by the CKS central database, the InView local database, the MultiPlan cache database, and the CDMS database. Unlisted Modules are not used by the CyberKnife System. References in the right column are to the DICOM standard, Part 3 (Information Object Definitions). Table 4. Modules received and imported by the CKS central database Module Name Patient General Study General Series Frame of Reference General Equipment General Image Image Plane Reference C.7.1.1 C.7.2.1 C.7.3.1 C.7.4.1 C.7.5.1 C.7.6.1 C.7.6.2 16 P/N 019055, Rev. N

AE Specifications Module Name Image Pixel Multi-Frame VOI LUT SOP Common CT Image MR Image XA Image PET Image Patient Study PET Series PET Isotope Reference C.7.6.3 C.7.6.6 C.11.2 C.12.1 C.8.2.1 C.8.3.1 C.8.7.1 C.8.9.4 C.7.2.2 C.8.9.1 C.8.9.2 The CTN_STORAGE/CTN_ARCHIVE/CDMS_STORAGE implements Level 2 (Full) conformance for the Storage SOP Class, but the CyberKnife System only uses a subset of the attributes as described in the Notes column. Table 5. Patient Module Patient Name (0010,0010) 2 PN Displayed to the user. User can modify the first time an image study for a given patient is imported to the CKS central database. Displayed in the InView System. Patient ID (0010,0020) 2 LO Only the "a-z", "A-Z", "0-9", "-", and "_" text are acceptable in the value of this attribute. Displayed to the user. This attribute is the key identifier in the CKS central database and CDMS database. Displayed in the InView System. Patient Birth Date (0010,0030) 2 TM Used to determine patient age. Patient Birth Time (0010,0032) 3 TM Not used. Patient Sex (0010,0040) 2 CS Sex of the named patient. Used in PET SUV calculation. P/N 019055, Rev. N 17

AE Specifications Table 6. General Study Module Study Instance UID (0020,000D) 1 UI Displayed to the user. Used to associate multiple images into a single case in the CKS central database. Displayed in the InView System. Study Date (0008,0020) 2 DA Displayed in the InView System. Study Time (0008,0030) 2 TM Not used. Referring Physician Name (0008,0090) 2 PN Displayed to the user. Can be modified by the user when image is imported to the CKS central database. Study ID (0020,0010) 2 SH Not used. Accession Number (0008,0050) 2 SH Not used. Study Description (0008,1030) 3 LO Displayed in the InView System. Table 7. General Series Module Modality (0008,0060) 1 CS Determine special processing required for interpretation of the image data. CKS currently supports CT, MR, PT, XA and RTSTRUCT. The InView System additionally supports RTDOSE. Series Instance UID (0020,000E) 1 UI Displayed in the InView System. Series Description (0008,103E) 3 LO Displayed in the InView System. Beginning with MultiPlan 2.0 and CyberKnife 7.0, it is used to initialize the CyberKnife respiration phase for GE and SIEMENS 4D CT scanners with the below conversion protocol. The conversion of GE : Accuray T=0% (full Inhale): 50% T=10% : 60% 18 P/N 019055, Rev. N

AE Specifications T=20% : 70% T=30% : 80% T=40% : 90% T=50% (full Exhale): 0% T=60% : 10% T=70% : 20% T=80% : 30% T=90% : 40% T=100%(full Inhale) : 50% The conversion of SIEMENS: Accuray 0% Exhale (=0% Inhale): 0% 20% Inhale: 10% 40% Inhale: 20% 60% Inhale: 30% 80% Inhale: 40% 100% Inhale (=100% Exhale): 50% 80% Exhale: 60% 60% Exhale: 70% 40% Exhale: 80% 20% Exhale: 90% Validated 4D CT scanners include: GE MEDICAL SYSTEMS, Discovery ST SIEMENS, Sensation Open Series Number (0020,0011) 2 IS Not used. Patient Position (0018,5100) 2C CS Determine the orientation of the scan for On-Target and FSN rendering. Currently CKS and MultiPlan support HFS, and FFS. However, the InView System only supports HFS. Series Date (0008,0021) 3 DA Date the Series started. Series Time (0008,0031) 3 TM Time the Series started. P/N 019055, Rev. N 19

AE Specifications Table 8. Frame of Reference Module Frame of Reference UID (0020,0052) 1 UI For CT and MR data, this attribute must be the same for every image in the series. Table 9. General Equipment Module Manufacturer (0008,0070) 2 LO Required for validation in CKS. Validated CT scanners include: GE MEDICAL SYSTEMS, LightSpeed16, LightSpeed Plus, LightSpeed Pro16, LightSpeed QX/i, LightSpeed Ultra, Discovery LS, HiSpeed, HiSpeed LX\i, HiSpeed QX\i, HiSpeed NX/i Marconi Medical Systems, PQ5000 (Picker) Philips, Mx8000, Mx8000 IDT, PQ5000 SIEMENS, Volume Zoom, SOMATOM PLUS 4, Emotion, Emotion Duo, Somatom Sensation 16 Varian Medical Systems, CTScanner TOSHIBA, Aquilion Validated MR scanners include: GE MEDICAL SYSTEMS, GENESIS_SIGNA, SIGNA EXCITE Philips Medical Systems, Gyroscan Intera (Picker), ACS SIEMENS, MAGNETOM VISION, Symphony, Harmony Expert Canon Medical Systems Validated PET scanners include: GE MEDICAL SYSTEMS, Discovery LS, Discovery QX\i CPS, 1023/1062/1080 Validated XA scanners include: Philips Medical Systems, Integris 3D-RA Release2 Validated Workstations include: Marconi Medical Systems, AcQSim, 20 P/N 019055, Rev. N

AE Specifications VARIAN Medical Systems, Vision 7.1 (Somavision), Vision 7.1/7.2/7.3(Eclipse) MDS NORDION, TheraplanPlus, Helax-TMS ADAC, Pinnacle3 NOMOS CORVUS5.0 GE AdvantageSim 3DLine DYART MIMvista FUSION See also Manufacturer Model Name (0008, 1090) for more specific models. InView uses Accuray Inc. to check if DICOM RT comes from Accuray. Pixel Padding Value (0028,0120) 3 SS Not used. Table 10. General Image Module Instance Number (0020,001 3) Acquisition Date (0008 0022) Acquisition Time (0008 0032) 2 IS Not used. 3 DT Used in PET SUV calculation The date the acquisition of data that resulted in this image started. 3 TM Used in PET SUV calculation The time the acquisition of data that resulted in this image started. Table 11. Image Plane Module Pixel Spacing (0028,0030) 1 DS Physical distance in the patient between the center of each pixel. Image Orientation (Patient) (0020,0037) 1 DS CKS uses this info to reorient image buffer in different patient position (0018, 5100). The MultiPlan and InView Systems use this info to define the patient coordinate system. Image Position (0020,0032) 1 DS CKS uses the value of the X and Y coordinates to P/N 019055, Rev. N 21

AE Specifications (Patient) recalculate the ROI coordinates of RT Structure Set in On-Target. CKS uses the value of the Z coordinate to determine slice thickness and slice number. The MultiPlan and InView Systems use this info to define the patient coordinate system. Slice Thickness (0018,0050) 2 DS CKS uses to identify variable slice thickness errors. Default 10% tolerance can be modified. Slice Location (0020,1041) 3 DS Not used. Table 12. Image Pixel Module Samples per Pixel (0028,0002) 1 US Must be 1. Photometric Interpretation (0028,0004) 1 CS Must be MONOCHROME1 or MONOCHROME2 Rows (0028,0010) 1 US Number of rows in the image Columns (0028,0011) 1 US Number of columns image Bits Allocated (0028,0100) 1 US Number of bits allocated for each pixel sample. Bits Stored (0028,0101) 1 US Number of bits stored for each pixel sample. High Bit (0028,0102) 1 US Most significant bit for each pixel sample. Pixel Representation (0028,0103) 1 US Data representation of the pixel samples. CKS currently supports both unsigned integer and 2 s complement. Pixel Data (7FE0,0010) 1 OW Pixel Data. Pixel Aspect Ratio (0028,0034) 1C IS Must be 1/1. 22 P/N 019055, Rev. N

AE Specifications Table 13. Multi-Frame Number of Frames (0028,0008) 1 IS The number of pixel in Z coordinate for dose volume, i.e. 3D dose grid. Required for the InView and MultiPlan Systems. Beginning with MultiPlan 4.5, 2D planar dose export with value=1 is not supported by theinview and Multiplan Systems. Frame Increment Pointer (0028,0009) 1 AT Table 14. VOI LUT Module Window Center (0028,1050) 3 UI Not used. Window Width (0028,1051) 1C UI Not used. 4.1.3.4.1 SOP Common Module SOP Class UID (0008,0016) 1 UI Not used. SOP Instance UID (0008,0018) 1 UI Not used. Table 15. CT Image Module Image Type (0008,0008) 1 CS ORIGINAL/PRIMARY/AXIAL or ORIGINAL/PRIMARY/LOCALIZER which indicates scout image in Picker CT scanner. DERIVED/SECONDARY indiciates mixed or fused image from the MultiPlan and InView Systems. Samples per Pixel (0028,0002) 1 US Value = 1 Photometric Interpretation (0028,0004) 1 CS MONOCHROME1 or MONOCHROME2 Bits Allocated (0028,0100) 1 US Value = 16 Bits Stored (0028,0101) 1 US Value = 12 to 16 High Bit (0028,0102) 1 US Value = 11 to 15 Rescale Intercept (0028,1052) 1 DS The value b in relationship between stored P/N 019055, Rev. N 23

AE Specifications value (SV) and Hounsfield (HU). HU = m * SV + b Used to scale data to CT number (CT) via Hounsfield Units in On-Target. CT = HU + 1000 = m*sv + b + 1000. Rescale Slope (0028,1053) 1 DS m in the equation specified in Rescale Intercept (0028,1052). Used to scale data to CT number via Hounsfield Units in On-Target. Gantry/Detector Tilt (0018,1120) 3 DS If present, Value = zero. Otherwise, CKS does not allow import to the central database. Table 16. MR Image Module Image Type (0008,0008) 1 CS ORIGINAL/PRIMARY/OTHER or DERIVED/SECONDARY or T1-MAP In the MultiPlan and InView Systems, DERIVED/SECONDARY indicates mixed and/or fused image exported from the MultiPlan and InView Systems. Beginning with MultiPlan 4.5, T1 MAP indicates T1-weighted MR imageand will used by the MultiPlan application to identify T1-weighted MR datasets. Samples per Pixel (0028,0002) 1 US Value = 1 Photometric Interpretation (0028,0004) 1 CS MONOCHROME1 or MONOCHROME2 Bits Allocated (0028,0100) 1 US Value = 16 24 P/N 019055, Rev. N

AE Specifications Table 17. XA Image Module Image Type (0008,0008) 1 CS DERIVED/SECONDARY indicates the reconstructed 3DRA image from Philips Integris scanner. Samples per Pixel (0028,0002) 1 US Value = 1 Photometric Interpretation (0028,0004) 1 CS MONOCHROME2 Bits Allocated (0028,0100) 1 US Value = 16 Table 18. PET Image Module Image Type (0008,0008) 1 CS ORIGINAL/PRIMARY or DERIVED/SECONDARY indicates mixed or fused image from the MultiPlan and InView Systems. Samples per Pixel (0028,0002) 1 US Value = 1 Photometric Interpretation (0028,0004) 1 CS MONOCHROME2 Bits Allocated (0028,0100) 1 US Value = 16 Bits Stored (0028,0101) 1 US Value = 16 High Bit (0028,0102) 1 US Value = 15 Rescale Intercept (0028,1052) 1 DS Value = 0 The value b in relationship between stored value (SV) and Hounsfield (HU). HU = m * SV + b Used to scale data to pixel number (PET) via Hounsfield Units in On-Target. PET = HU + 1000 = m*sv + b + 1000. Rescale Slope (0028,1053) 1 DS m in the equation specified in Rescale Intercept (0028,1052). Used to scale data to pixel number via Hounsfield Units in On-Target. Frame Reference Time (0054,1300) 1 DS Not used Image Index (0054,1330) 1 US Not used P/N 019055, Rev. N 25

AE Specifications Table 19. Patient Study Module Patient Age (0010,1010) 3 AS Age of the Patient. Patient Size (0010,1020) 3 DS Length or size of the Patient, in meters. Patient Weight (0010,1030) 3 DS Weight of the Patient, in kilograms. Table 20. PET Series Module Series Date (0008,0021) 1 DA Date the Series started. Series Time (0008,0031) TM Time the Series started. Units (0054,1001) 1 CS Pixel value units. Value= CNTS, BQML, PROPCPS, CPS, PROCNTS Counts Source (0054,1002) 1 CS The primary source of counts. The primary source leads to the underlying image Units (0054,1001), as opposed to secondary sources which are used during reconstruction correction. Enumerated Values: EMISSION TRANSMISSION Series Type (0054,1000) 1 CS A multi-valued indicator of the type of Series. See C.8.9.1.1.4 for explanation. Value 1 Enumerated Values: STATIC DYNAMIC GATED WHOLE BODY Value 2 Enumerated Values: IMAGE REPROJECTION Reprojection Method (0054,1004) 2C CS Not used. Number of R-R Intervals (0054,0061) 1C US Not used. Number of Time Slots (0054,0071) 1C US Not used. Number of Time Slices (0054,0101) 1C US Not used 26 P/N 019055, Rev. N